A 40-year-old man comes to the emergency department 30 minutes after experiencing a seizure. Over the past 3 months, the patient has had several episodes of brief twitching of the right hand, but today the abnormal movement gradually progressed to involve the entire right upper extremity, followed by shaking of the whole body for about a minute. He also lost consciousness and urinated involuntarily during the event. The patient feels groggy and has a mild headache. He has no other medical conditions but reports several concussions from playing football in college. Vital signs are within normal limits. Physical examination shows mild weakness of right hand grip but is otherwise normal. This patient's seizure presentation is most suggestive of which of the following etiologic processes?

Question

A 40-year-old man comes to the emergency department 30 minutes after experiencing a seizure.  Over the past 3 months, the patient has had several episodes of brief twitching of the right hand, but today the abnormal movement gradually progressed to involve the entire right upper extremity, followed by shaking of the whole body for about a minute.  He also lost consciousness and urinated involuntarily during the event.  The patient feels groggy and has a mild headache.  He has no other medical conditions but reports several concussions from playing football in college.  Vital signs are within normal limits.  Physical examination shows mild weakness of right hand grip but is otherwise normal.  This patient's seizure presentation is most suggestive of which of the following etiologic processes?

Quizplus · Accepted Answer

Eductional Objective: Focal-onset seizures most commonly occur due to a focal structural abnormality (eg, stroke, neoplasm) that causes a region of hyperexcitable neuronal activity in one cerebral hemisphere.  These seizures begin with localized symptomatology (eg, muscle twitching, paresthesia) and are classified according to level of consciousness (eg, aware, impaired awareness).  They can progress to bilateral tonic-clonic seizures if the excitatory neuronal activity spreads to involve both cerebral hemispheres.

A 40-Year-Old Man Comes to the Emergency Department 30 Minutes